title: Determining the quality of IMCI pneumonia care in Malawian children.
abstract: BACKGROUND
  Although pneumonia is the leading cause of child mortality worldwide, little is known about the quality of routine pneumonia care in high burden settings like Malawi that utilize World Health Organization's Integrated Management of Childhood Illnesses (IMCI) guidelines. Due to severe human resource constraints, the majority of clinical care in Malawi is delivered by non-physician clinicians called Clinical Officers (COs).
  
  
  OBJECTIVE
  To assess the quality of child pneumonia care delivered by Malawian COs in routine care conditions.
  
  
  METHODS
  At an outpatient district-level clinic in Lilongwe, Malawi, 10 COs caring for 695 children who presented with fever, cough, or difficulty breathing were compared to IMCI pneumonia diagnostic and treatment guidelines.
  
  
  RESULTS
  Fewer than 1% of patients received an evaluation by COs that included all 16 elements of the history and physical examination. The respiratory rate was only determined in 16.1% of patients presenting with cough or difficulty breathing. Of the 274 children with IMCI-defined pneumonia, COs correctly diagnosed 30%, and administered correct pneumonia care in less than 25%. COs failed to hospitalize 40.8% of children with severe or very severe pneumonia.
  
  
  CONCLUSIONS
  IMCI pneumonia care quality at this Malawian government clinic is alarmingly low. Along with reassessing current pneumonia training and supervision approaches, novel quality improvement interventions are necessary to improve care.
authors.forename: Erica
authors.initials: E
authors.lastname: Bjornstad
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Preidis
authors.forename: Norman
authors.initials: N
authors.lastname: Lufesi
authors.forename: Dan
authors.initials: D
authors.lastname: Olson
authors.forename: Portia
authors.initials: P
authors.lastname: Kamthunzi
authors.forename: Mina C
authors.initials: MC
authors.lastname: Hosseinipour
authors.forename: Eric D
authors.initials: ED
authors.lastname: McCollum
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019033:Delivery of Health Care, Integrated; D005260:Female; D006302:Health Services Research; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008295:Malawi; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000188:drug therapy*
keywords: Developing countries,; Guidelines,; Paediatrics; Pneumonia,